title: A semi-automated region of interest detection method in the scintigraphic glomerular filtration rate determination for patients with abnormal low renal function.
abstract: OBJECTIVE
  This work presents a novel semi-automated renal region-of-interest (ROI) determination method that is user friendly, time saving, and yet provides a robust glomerular filtration rate (GFR) estimation highly consistent with the reference method.
  
  
  METHODS
  We reviewed data from 57 patients who underwent (99m)Tc-diethylenetriaminepentaacetic acid renal scintigraphy and were diagnosed with abnormal renal function. The renal and background ROIs were delineated by the proposed multi-step, semi-automated method, which integrates temporal/morphologic information via visual inspection and computer-aided calculations. The total GFR was estimated using the proposed method (sGFR) performed by 2 junior clinicians (A and B) with 1 and 3 years of experience, respectively (sGFR_a, sGFR_b), and compared with the reference total GFR (rGFR) estimated by a senior clinician with 20 years of experience who manually delineated the kidney and background ROIs. All GFR calculations herein were conducted using the Gates method.
  
  
  RESULTS
  Data from 10 patients with unilateral or non-functioning kidneys were excluded from the analysis. For the remaining patients, sGFR correlated well with rGFR (r(s/rGFR_a) = 0.957, P < 0.001 and r(s/rGFR_b) = 0.951, P < 0.001) and sGFR_a correlated well with sGFR_b (r(a/b) = 0.997, P < 0.001). Moreover, the Bland-Altman plots for sGFR_a and sGFR_b confirm the high reproducibility of the proposed method between different operators. Finally, the proposed procedure is almost 3 times faster than the routinely used procedure in clinical practice.
  
  
  CONCLUSIONS
  The results suggest that this method is easy to use, highly reproducible, and accurate in measuring the GFR of patients with low renal function. The method is being further extended to a fully automated procedure.
authors.affiliation: From the *School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; †Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; and ‡Banner Alzheimer's Institute, Phoenix, AZ.
authors.forename: Cancan
authors.initials: C
authors.lastname: Tian
authors.forename: Xiujuan
authors.initials: X
authors.lastname: Zheng
authors.forename: Yuan
authors.initials: Y
authors.lastname: Han
authors.forename: Xiaoguang
authors.initials: X
authors.lastname: Sun
authors.forename: Kewei
authors.initials: K
authors.lastname: Chen
authors.forename: Qiu
authors.initials: Q
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001331:Automation; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging / Q000379:methods*; D012044:Regression Analysis; D016284:Technetium Tc 99m Pentetate; D055815:Young Adult
chemical_list: D016284:Technetium Tc 99m Pentetate